Preliminary Development and Evaluation of an Algorithm to Identify Breast Cancer Chemotherapy Toxicities Using Electronic Medical Records and Administrative Data

Abstract

Purpose: Breast cancer chemotherapy toxicity is not well documented outside of randomized trials. We developed and conducted preliminary evaluation of an algorithm to detect grade 3 and 4 toxicities using electronic data from a large integrated managed care organization. Methods:The algorithm used administrative, pharmacy, and electronic data from outpatient, emergency room, and inpatient records of 99 women diagnosed with breast cancer from 2006 to 2009 who underwent chemotherapy. Data were abstracted for 12 months post-treatment initiation (24 months for trastuzumab recipients). An oncology nurse independently blindly reviewed records; these results were the "gold standard." Sensitivity and specificity were calculated for overall toxicity, categories of toxicities, and toxicity by age or regimen. The algorithm was applied to an independent sample of 1,575 patients with breast cancer diagnosed during the study period to estimate prevalence rates. Results:The overall sensitivity for detecting chemotherapyrelated toxicity was 89% (95% CI, 77% to 95%). The highest sensitivity was for identification of hematologic toxicities (97%; 95% CI, 84% to 99%). There were good sensitivities for infectious toxicity, but rates dropped for GI and neurological toxicities. Specificity was high within each category (89% to 99%), but when combined to measure any toxicity, it was lower (70%; 95% CI, 57% to 81%). When applied to an independent chemotherapy sample, the algorithm estimates a 26% rate of hematologic toxicity; rates were higher among patients age Ն 65 years versus less than 65 years. Conclusions:If validated in other samples and health care settings, algorithms to capture toxicity could be useful in comparative and cost-effectiveness evaluations of community practice-delivered treatment.

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)

“…4,7 The functional status items were derived from two short, easy to administer patient-report scales. Since comorbidity is routinely collected, addition of short, questionnaire-based functional assessments could provide a feasible frailty assessment for use in clinical encounters and inclusion in electronic health records, thereby increasing the reach of geriatric assessment in practice settings.…”

“…1 These older patients exhibit variability in health and system reserve, even at similar chronological ages. 2-4 Clinically meaningful decrements in reserve are not always apparent and can go unrecognized in routine oncology encounters. 5 Knowledge about system reserve could influence treatment decision-making, 3,6 and predict tolerance of systemic therapy and survival.…”

Variation in the Assessment of Immune-Related Adverse Event Occurrence, Grade, and Timing in Patients Receiving Immune Checkpoint Inhibitors

“…Potential strategies include embedding more than 1 observer in the assessment or review of irAE and using automated tools and collateral data to reduce physician effort. 22,23…”

Using electronic medical record data to report laboratory adverse events

“…We and others have sought to improve AE reporting with automated data extraction from the electronic medical record (EMR) (Mandelblatt et al , ; Lencioni et al , ). Mandelblatt et al () ascertained AEs in breast cancer patients with an overall sensitivity of 89% (range 0–100%), but did not report positive predictive value (PPV).…”

“…We and others have sought to improve AE reporting with automated data extraction from the electronic medical record (EMR) (Mandelblatt et al , ; Lencioni et al , ). Mandelblatt et al () ascertained AEs in breast cancer patients with an overall sensitivity of 89% (range 0–100%), but did not report positive predictive value (PPV). Lencioni et al () incorporated EMR AE capture in one hospital system to streamline AE collection, but did not provide a methodology for improving AE reporting on multi‐centre trials.…”